Observational studyCirculation2015
Sex differences in perceived stress and early recovery in young and middle-aged patients with acute myocardial infarction.
Open access · bronzeAbstract readObservational Study
In one paragraph
Observational study in Circulation, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 61 papers, 2 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
61citing papers in PubMed, 2 pooled it
12.7field-weighted citation impact, top 1% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
61 citing papers in PubMed, 2 syntheses or guidelines pooled it, 145 citations in OpenAlex.
- Pooled it
- What Do We Know About Young Adult Cardiac Patients' Experience? A Systematic Review.Frontiers in psychology · 2020Pooled it
- Coping Strategies Influence Cardiometabolic Risk Factors in Chronic Psychological Stress: A Post Hoc Analysis of A Randomized Pilot Study.Nutrients · 2021Trial
- Mental Stress-Induced-Myocardial Ischemia in Young Patients With Recent Myocardial Infarction: Sex Differences and Mechanisms.Circulation · 2018Trial
- Sex Differences in Clinical Characteristics, Psychosocial Factors, and Outcomes Among Patients With Stable Coronary Heart Disease: Insights from the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) Trial.Journal of the American Heart Association · 2017Trial
- Time-Trends in Case-Fatality After Acute Myocardial Infarction Among Middle-Aged Lithuanian Adults, 2000-2023: Data from the Population-Based Kaunas Ischemic Heart Disease Register.Medicina (Kaunas, Lithuania) · 2026Article
- Gender-based distribution of depression and anxiety following acute coronary syndrome in the Turkish population: are women at higher risk?BMC cardiovascular disorders · 2025Observational
- Depressive symptoms partially mediate the relationship between psychosocial factors and epigenetic age acceleration in a multi-racial/ethnic sample of older adults.Brain, behavior, & immunity - health · 2025Article
- In-hospital systolic blood pressure lowering patterns and risk of rehospitalization for angina in patients with hypertension and coronary artery disease.Hypertension research : official journal of the Japanese Society of Hypertension · 2025Article
- Brief Mindfulness-Based Cognitive Therapy in Women With Myocardial Infarction: Results of a Multicenter Randomized Controlled Trial.JACC. Advances · 2025Article
- Sex differences in in-hospital outcomes and readmission rates after percutaneous coronary intervention.Proceedings (Baylor University. Medical Center) · 2025Article
- Gender-specific impact of stress and adiposity on autonomic stress modulation in teachers.Frontiers in psychology · 2025Article
- Bridging the Gender Gap in Cardiovascular Medicine: Addressing Drug Intolerances and Personalized Care for Women with Angina/Ischemia with Non-Obstructive Coronary Artery Disease.Journal of cardiovascular development and disease · 2024Review
- Nutritional habits and eating attitude in university students during the last wave of COVID-19 in Spain.Scientific reports · 2024Article
- Stress and cardiovascular disease: an update.Nature reviews. Cardiology · 2024Review
- Prognostic factors of MINOCA and their possible mechanisms.Preventive medicine reports · 2024Review
- Psychosocial Factors of Women Presenting With Myocardial Infarction With or Without Obstructive Coronary Arteries.Journal of the American College of Cardiology · 2023Article
- Psychological stress is associated with arterial inflammation in people living with treated HIV infection.Brain, behavior, and immunity · 2023Article
- Depression Following Acute Coronary Syndrome: A Review.Reviews in cardiovascular medicine · 2023Review
- Life's simple 7 and its association with trajectories in depressive symptoms among urban middle-aged adults.Journal of affective disorders · 2023Article
1 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors at 3 institutions in 1 country.
Xiao XuFrom the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.).
Haikun BaoFrom the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.).
Kelly StraitFrom the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.).
John A SpertusFrom the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.).
Judith H LichtmanFrom the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.).
Gail D'OnofrioFrom the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.).
Erica SpatzFrom the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.).
Emily M BucholzFrom the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.).
Mary GedaFrom the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.).
Nancy P LorenzeFrom the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.).
Héctor BuenoFrom the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.).
John F BeltrameFrom the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.).
Harlan M KrumholzFrom the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.). harlan.krumholz@yale.edu.
Saint Luke's Hospital · USYale New Haven Hospital · USYale University · US
Funding
MEDICAL SCIENTIST TRAINING PROGRAMT32GM007205 · NIGMS · YALE UNIVERSITY · PI KAZMIERCZAK, BARBARA I · 1985 to 2019
$42.9MYoung Women With Acute Myocardial InfarctionR01HL081153 · NHLBI · YALE UNIVERSITY · PI KRUMHOLZ, HARLAN MARC · 2007 to 2012
$10.6MCenter for Cardiovascular Outcomes Research at Yale UniversityU01HL105270 · NHLBI · YALE UNIVERSITY · PI CURTIS, JEPTHA PELHAM, KRUMHOLZ, HARLAN MARC · 2010 to 2013
$5.8MNHLBI NIH HHS R01 HL081153NHLBI NIH HHS R01 HL081153-01A1KNHLBI NIH HHS U01 HL105270NIGMS NIH HHS T32 GM007205
Abstract
backgroundYounger age and female sex are both associated with greater mental stress in the general population, but limited data exist on the status of perceived stress in young and middle-aged patients presenting with acute myocardial infarction. METHODS AND
resultsWe examined sex difference in stress, contributing factors to this difference, and whether this difference helps explain sex-based disparities in 1-month recovery using data from 3572 patients with acute myocardial infarction (2397 women and 1175 men) 18 to 55 years of age. The average score of the 14-item Perceived Stress Scale at baseline was 23.4 for men and 27.0 for women (P<0.001). Higher stress in women was explained largely by sex differences in comorbidities, physical and mental health status, intrafamily conflict, caregiving demands, and financial hardship. After adjustment for demographic and clinical characteristics, women had worse recovery than men at 1 month after acute myocardial infarction, with mean differences in improvement score between women and men ranging from -0.04 for EuroQol utility index to -3.96 for angina-related quality of life (P<0.05 for all). Further adjustment for baseline stress reduced these sex-based differences in recovery to -0.03 to -3.63, which, however, remained statistically significant (P<0.05 for all). High stress at baseline was associated with significantly worse recovery in angina-specific and overall quality of life, as well as mental health status. The effect of baseline stress on recovery did not vary between men and women.
conclusionsAmong young and middle-aged patients, higher stress at baseline is associated with worse recovery in multiple health outcomes after acute myocardial infarction. Women perceive greater psychological stress than men at baseline, which partially explains women's worse recovery.
Indexed as
Recovery of FunctionSex CharacteristicsAdolescentAdultAge FactorsFemaleHumansMaleMiddle AgedMyocardial InfarctionPerceptionProspective StudiesStress, PsychologicalTime FactorsYoung Adultmyocardial infarctionrecovery of functionsex characteristicsstress, psychological
Identifiers
What OpenQuestion holds
Textmetadata
LicenceTDM
Read underepoch 390
Registered trials
None linked
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.